The quest for the magic bullet: Centoxin, Drotrecogin Alfa and lessons not learned

The challenges of sepsis, the inflammatory cascade and multi organ failure have remained central to the practice of critical care medicine for the last quarter of a century. The change in attitude and understanding of the natural history of sepsis and its optimal medical management has reflected a progressive change in the perception of its biology, informed by the results of clinical trials delivering mixed messages. In terms of human behaviours, the rise and fall of activated protein C (Drotrecogin Alfa) has some similarities to the rise and fall of Centoxin; but in other respects, including the underlying science, the stories are very different indeed. In this article, we will outline the two stories, highlighting both similarities in the medical community response to the early trial data, and the differences in the lessons we can learn from the two experiences.